Director, Provider Network Operations

PACIFICSOURCE

. Guide strategic initiatives for Provider Network Operations, including network setup and maintenance, provider data integrity, provider education and service, contract implementation, provider-related claims, provider setup and audits, corrective action plans, and provider directory accuracy .

Posted 10/26/2026full-timeRemote • Virginia • United StatesLead💰 $108,469 - $184,397 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare provider network operations, including provider reimbursement methodologies, compliance requirements, and strategic planning. Proven ability to lead multi-level teams, develop provider education programs, and ensure operational excellence across diverse departments.

Highest-signal resume keywords

Provider Network Operations LeadershipProvider Reimbursement MethodologiesCompliance Requirements KnowledgeStrategic Planning and ExecutionTeam Development and Coaching

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Provider Data ManagementCredentialingOperational ExcellenceLEAN MethodologiesData Synchronization ProcessesPerformance MonitoringBudget ManagementHealthcare Data ManagementProvider Education Program DevelopmentInnovative Provider Payment Methodologies

Soft Skills

Collaborative InteractionAccountable LeadershipInfluential CommunicationSituational LeadershipEmpowerment

Tools & Technologies

Provider Network PlatformsInteroperability SystemsAutomated WorkflowsFinancial BudgetsPerformance Metrics

Industry Keywords

Healthcare OperationsNCQA StandardsHIPAA ComplianceMatrixed OrganizationProvider Relations

About the role

Key responsibilities & impact

Guide strategic initiatives for Provider Network Operations, including network setup and maintenance, provider data integrity, provider education and service, contract implementation, provider-related claims, provider setup and audits, corrective action plans, and provider directory accuracy
Collaborate with Provider Reimbursement Insights and Analytics to meet objectives
Direct Credentialing division efforts to ensure compliance and operational excellence
Develop provider education and relationship management strategies
Lead integration and operational effectiveness of provider network platforms with legacy and emerging systems
Partner with software vendors, IT teams, and internal stakeholders to improve interoperability and system compatibility
Ensure integrated systems support state, federal, and NCQA standards and organizational policies
Develop automated workflows and data synchronization processes across platforms and departments
Improve functionality through LEAN methodologies and resources
Participate in strategic planning, execution, resource allocation, and performance monitoring
Work with executive leadership on processes, technology, people resources, performance metrics, and efficiency targets
Oversee provider collaborative efforts and coordinate with other departments and leaders
Guide functional leaders in developing business plans
Design and deliver provider education programs
Assess provider feedback and implement relationship improvements
Collaborate with Operations, IT, Health Services, Analytics, Finance, and other departments
Oversee annual IT work plans, initiative work plans, financial budgets, and resource needs
Develop coaching and training programs with division leaders
Oversee hiring, staff development, coaching, performance reviews, and employee engagement
Oversee division budgets and spending and implement corrective actions as needed
Participate in Manager/Supervisor meetings, PRISM walks, internal committees, and department activities
Assess innovative provider payment methodologies for approval and implementation
Meet department and company performance and attendance expectations
Follow privacy and HIPAA requirements
Perform other duties as assigned

Requirements

What you’ll need

Minimum of 8 years of experience in a leadership role overseeing healthcare provider network operations or related functions
Experience leading at least two of Provider Relations, Credentialing, and Provider Data Management strongly preferred
Experience managing large, multi-level teams and complex operational portfolios
Knowledge of provider reimbursement methodologies, provider network operations, compliance requirements, and healthcare data management
Experience developing and executing strategy within a matrixed organization preferred
Bachelor’s degree in business, health care administration, finance, or related field required
Associate’s degree and 2 years of relevant experience, or high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered
Ability to develop and execute strategy
Advanced knowledge of provider reimbursement and reimbursement methodologies, provider relations, or provider partnership activities
Ability to lead people in a matrixed organization structure and build high performing teams
Proven collaborative interaction experience with provider leaders
Accountable leadership, business and financial acumen, empowerment, influential communications, situational leadership, and strategic planning
Ability to read and comprehend both written and spoken English
Ability to communicate clearly and effectively
Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive motions, and lift and carry files and business materials
Compliance with PacificSource privacy policy and HIPAA laws and regulations

Benefits

Comp & perks

Equal opportunity employment
Work-from-home arrangement
Coaching and training programs
Employee engagement and cultural enhancement programs
Career development and staff development opportunities
Approximately 15% travel opportunity